ID 1 - abx classes but maybe just beta-lactams idk yet gals

beta-lactams exhibit what kind of pharmacodynamics?

a. concentration-dependent

b. exposure-dependent

c. time-dependent

c. time-dependent

beta-lactam abx

• penicillins

• cephalosporins

• carbapenems

are beta-lactams

a. bactericidal

b. bacteriostatic

a. bactericidal

beta-lactam ring

beta-lactam MOA

inhibit bacterial cell wall synthesis

bind to PBPs —> prevents the final step of peptidoglycan synthesis in bacterial cell walls

do any beta-lactams have activity against atypicals?

NO

atypicals do NOT have a cell wall and that’s legit how beta-lactams work

natural penicillins cover:

• gram+ cocci

  • streptococci

  • enterococci

  • NOT STAPH

• gram+ anaerobes (mouth flora)

antistaphylococcal penicillins cover:

• streptococci

• MSSA

• NO ENTEROCOCCUS

aminopenicillins cover:

• streptococci

• enterococci

• gram+ anaerobes (mouth flora)

• gram- bacteria

  • haemophilus

  • neisseria

  • proteus

  • e coli

what is a key coverage point of ampicillin?

listeria

aminopenicillins with BLIs cover:

• strep

• enterococcus

• MSSA

• more resistant gram- bacteria (HNPEK)

• gram- anaerobes (b fragilis)

zosyn (piperacillin/tazobactam) coverage

• streptococcus

• enterococcus

• MSSA

• gram- (HNPEK) (SPACE)

• pseudomonas

natural penicillins

• penicillin VK

• penicillin G aqueous

• penicillin G benzathine (Bicillin LA)

which natural penicillin is given via IV?

a. penicillin VK

b. penicillin G aqueous

c. penicillin G benzathine (Bicillin LA)

b. penicillin G aqueous

which natural penicillin is given via IM injection?

a. penicillin VK

b. penicillin G aqueous

c. penicillin G benzathine (Bicillin LA)

c. penicillin G benzathine (Bicillin LA)

antistaphylococcal penicillins

• dicloxacillin

• nafcillin

• oxacillin

which antistaph penicillin is given via IV? (SATA)

a. dicloxacillin

b. nafcillin

c. oxacillin

b. c.

aminopenicillins

• amoxicillin

• ampicillin

if we’re choosing an aminopenicillin to give orally, which one should we choose because it has better bioavailability?

a. amoxicillin

b. ampicillin

a. amoxicillin

CI to penicillins

type 1 hypersensitivity reaction to another penicillin or beta-lactam

when do we not use augmentin ER or 875 mg?

CrCl < 30

ADRs of penicillins

• seizures — accumulation

• GI upset

• diarrhea

• rash

• allergic rxn/anaphylaxis

• hemolytic anemia — positive Coombs test

when are antistaphylococcal penicillins preferred?

MSSA soft tissue, bone/joint, endocarditis, and bloodstream infections

how do you treat extravasation of nafcillin?

cold packs

hyaluronidase

______ can increase the levels of beta-lactams

probenecid

when do we still use penicillin even if someone has a beta-lactam allergy?

tx of syphilis during pregnancy or poor adherence/follow-up — desensitize and treat with penicillin G benzathine

what is penicillin VK primarily used for?

pharyngitis (strep throat)

what is amoxicillin used for?

• acute otitis media

• infective endocarditis prophylaxis before dental procedures

• h. pylori regimens

what is the pediatric dose of amoxicillin for AOM?

80-90 mg/kg/day

what is the dose of amoxicillin for infective endocarditis prophylaxis before dental procedures?

2 g PO x 1, 30-60 mins prior to procedure

what is penicillin G benzathine (Bicillin LA) primarily used for?

syphilis

what is the dose of penicillin G benzathine for syphilis?

2.4 million units IM

what is augmentin used for first-line?

• acute otitis media

• bacterial sinusitis

what pediatric dose of augmentin is used for AOM?

90 mg/kg/day

what is the only penicillin active against pseudomonas?

zosyn (piperacillin/tazobactam)

what subclass of penicillins doesn’t require renal dose adjustments?

antistaphylococcal penicillins

• dicloxacillin

• nafcillin

• oxacillin

what is a way to maximize T > MIC for zosyn?

prolonged/extended infusions over 4 hours

which cephalosporins have activity against enterococcus and atypicals?

NONE

first gen cephalosporins activity

• excellent — gram+ cocci (strep, staph)

• some — gram- rods (PEK)

second gen cephalosporins activity

• gram + cocci (staph, more resistant strep pneumo)

• gram- (HNPEK)

• cefotetan and cefoxitin: gram- anaerobes (b fragilis)

third gen cephalosporins activity

• gram+ cocci

  • resistant strep (strep pneumo)

  • viridans group strep

  • staph (MSSA)

• gram+ anaerobes

• gram-: resistant HNPEK

• ceftazidime: no gram+ coverage, covers pseudomonas

what third generation cephalosporin covers pseudomonas?

ceftazidime

fourth generation cephalosporins coverage

• gram+ (same as third gen)

• gram-: HNPEK, SPACE

  • pseudomonas

which cephalosporins cover pseudomonas? (SATA)

a. ceftazidime

b. cefotetan

c. cefepime

d. ceftaroline

e. cefiderocol

a. c. e.

fifth generation cephalosporins activity

• gram- (similar to third gen)

• gram+: broad

  • MRSA

what are the only beta-lactams that cover MRSA?

fifth generation cephalosporins

• ceftaroline

• ceftobiprole

beta-lactamase + cephalosporin combos have what coverage?

similar to ceftazidime: no gram+, pseudomonas

plus MDR gram- rods

cefiderocol (siderophore cephalosporin) coverage

gram-

• PEK

• enterobacter

• pseudomonas

• CRE

first generation cephalosporins

• cefazolin

• cephalexin

• cefadroxil

second generation cephalosporins

• cefuroxime

• cefotetan

• cefoxitin

• cefaclor

• cefprozil

third generation cephalosporins

• cefdinir

• ceftriaxone

• cefotaxime

• cefixime

• cefpodoxime

• ceftazidime

fourth generation cephalosporins

• cefepime

fifth generation cephalosporins

• ceftaroline fosamil (Teflaro)

• ceftobiprole medocaril (Zevtera)

Avycaz

ceftazidime/avibactam

zerbaxa

ceftolozane/tazobactam

ceftriaxone contraindications

• hyperbilirubinemic neonates —> kernicterus

• concurrent use with calcium-containing IV products in neonates

what cephalosporin can cause a disulfiram-like reaction with alcohol ingestion?

cefotetan

ADRs of cephalosporins

• seizures — accumulation

• GI upset

• diarrhea

• rash

• allergic rxn/anaphylaxis

• hemolytic anemia — positive Coombs test

which cephalosporin does NOT require renal dose adjustment?

ceftriaxone

what is the typical dose of cephalexin?

250-500 mg PO Q6-12H

which cephalosporin will precipitate if given in the same line as calcium-containing IV fluids?

ceftriaxone

which cephalosporins should be separated by 2 hours from short-acting antacids and avoided with H2RAs and PPIs?

• cefuroxime

• cefpodoxime

• cefdinir

common uses of keflex

• skin infections (MSSA)

• strep throat

common uses of cefuroxime

• AOM

• CAP

• sinusitis

common uses of cefdinir

• AOM

• CAP

• sinus infections

which cephalosporins are commonly used for surgical prophylaxis?

cefazolin

cefotetan & cefoxitin: GI procedures

key point of coverage of cefotetan and cefoxitin (2nd gen)

anaerobe coverage (b fragilis)

carbapenems coverage

• most gram+

• most gram-: ESBL producing bacteria

  • pseudomonas

• anaerobes

which carbapenem has differing coverage?

does not cover pseudomonas, acinetobacter, or enterococcus

ertapenem

carbapenems

• meropenem (Merrem)

• ertapenem (Invanz)

• meropenem/vaborbactam (Vabomere)

• imipenem/cilastatin (Primaxin IV)

• imipenem/cilastatin/relebactam (Recarbrio)

warnings/ADRs of carbapenems

• do not use in PCN allergy

• CNS effects — confusion and seizures

• monitor renal function

what does ertapenem need to be diluted in?

normal saline

what are the organisms all carbapenems do NOT cover?

• atypicals

• VRE

• MRSA

• C diff

• stenotrophomonas

what are the organisms ertapenemm does NOT cover?

• pseudomonas

• enterococcus

• acinetobacter

aztreonam coverage

gram- organisms: pseudomonas and SPACE

NO GRAM+ or ANAEROBES

when is aztreonam (azactam) primarily used?

penicillin allergy present

beta-lactams that cover pseudomonas

• zosyn

• ceftazidime

• aztreonam

• cefepime

• cefiderocol

• ceftazidime/avibactam

• ceftolozane/tazobactam

• imipenem/cilastatin

• meropenem